New medical staff models: Examples from the field

Medical Staff Leader Insider, May 27, 2009

Successful organizations have discovered that the right medical staff-hospital relationship is the Holy Grail of strategic medical staff development planning. To this end, physicians and hospitals need to explore the various models and relationships that might help both parties achieve a higher degree of alignment. Make no mistake that organizations will need to show great flexibility to thrive. They will undoubtedly implement multiple medical staff models simultaneously, including self-governed medical staff, physician employment, contracts, physician-hospital council, physician executives, medical directors, joint ventures, etc.

Many organizations have asked me what other organizations are trying, and more importantly, what’s working. Clearly one size will not fit all. However, here are some examples gleaned from The Greeley Company’s work with a multitude of hospitals and health systems across the country:

The medical staff of a brand new hospital in the Midwest is designing a service line function as the basis for the organized medical staff. Service line directors will work with the medical executive committee, the credentials committee, and the multi-specialty peer review committee to carry out the board-delegated medical staff responsibilities after its 2010 opening.

The medical staff and hospital executive team at an organization in the North-Central part of the country have come together and laid out the structure and process for a physician advisory council to deal with strategic and operational issues. The impetus for this change was severe political rifts in the medical community that paralyzed the effectiveness and operations of the traditional medical staff structure. Part of this initiative will also include a task force to redesign the medical staff governance process.

A Northeast organization formalized a physician-hospital compact during a facilitated retreat involving the medical staff, board, and hospital executives. The process was set in motion when the board told the medical staff that it had no faith in the peer review process. This uncovered deep divides between the groups that had existed for years. The parties recognized that they were not moving forward adequately in their very competitive and unforgiving market and sought out a new basis on which to rebuild trust and communication.

A health system in the West has begun implementing a comprehensive assortment of options, including legal recruiting support through a management services organization, a physician hospital organization, and physician employment. The latter required a major cultural change as this is something that “just isn’t done here.”

A health system in the mid-Atlantic region is considering implementing a physician executive model anchored by a strong chief medical officer and supported by key contracted clinical medical directors and paid clinical department chairs.

I am very much interested in hearing from the medical staff and hospital leaders facing these challenges every day. If your medical staff has successfully implemented alternative physician-hospital relationships, I’d love to hear from you. To share your tips, strategies, and success stories, please e-mail associate editor Elizabeth Jones at ejones@hcpro.com.

Until next time, be the best that you can be.

William Cors, MD, MMM, CMLS is the vice president of medical staff services at The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.

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